Getting a second opinion

A second opinion is a meeting with a doctor you haven’t seen for your current breast cancer diagnosis. You may want a second opinion to confirm your diagnosis or to review the recommended treatment. Many people diagnosed with breast cancer seek second opinions, and most doctors are comfortable when their patients seek second opinions.

Why seek a second opinion?

There are many reasons to get a second opinion. You may wish to:

• Confirm your diagnosis and make sure the cancer pathology report is accurate and that you understand it
• Understand all of your treatment options
• Find clarity and understanding from a different doctor’s words and recommendations
• Get help and guidance while choosing between a number of treatment options
• Learn about clinical trials offered at other hospitals
• Find a specialist who has more experience than your original oncologist with your specific type of breast cancer. For example, some breast cancer specialists see a lot of people with disease types that are not often seen in other practices, such as triple-negative and inflammatory breast cancers or breast cancer in young women.
• Seek a different opinion if you disagree with your doctor about the diagnosis or the treatment recommendations
• Find a doctor you feel more comfortable with than your current doctor
• Be treated at a different cancer center
• Provide your health insurance provider with a second opinion if the provider asks you to seek another opinion before starting treatment
• Gain peace of mind that you’re choosing a treatment plan that is right for you

When should I get a second opinion?

Throughout your diagnosis and treatment path, you can seek a second opinion more than once. It’s normal to want to get a second opinion at different points along the way so you can feel confident in your cancer treatment plan.

It's useful to get a second opinion:

• When you are first diagnosed with breast cancer, usually after getting the pathology report, but before starting any treatment, including surgery. A second opinion might help because:
  • Your pathology report determines your diagnosis; the report includes information about cancer tissue from the biopsies and surgeries you may have had, including the type of breast cancer, where it is located, and its stage, size, and grade
  • Sometimes, a diagnosis is not accurate
  • Another pathologist's opinion can help ensure your diagnosis is correct
• If you have uncertain test results, such as mammogram or ultrasound results, to evaluate a breast lump or change
• If you have fertility concerns and your doctor dismisses your concerns or does not offer to refer you to a reproductive endocrinologist
• If your treatment stops working and new treatment, or no treatment, is suggested
• If you are unsatisfied with the care, treatment, or answers you are getting from your doctors
• If you need clarity on a follow-up plan after finishing treatment
• If you have a recurrence (if breast cancer comes back)
• If you have metastatic breast cancer, since treatment is ongoing. You may want a second opinion if:
  • The cancer grows or spreads
  • You want to see a doctor or specialist with more knowledge of new approaches to metastatic breast cancer
  • You are not getting relief for side effects
  • You want to find better access to clinical trials for metastatic breast cancer

Certain breast cancers require treatment decisions right away, so there isn’t much time to get a second opinion. But in most cases, you can take the time you need to seek a second opinion and carefully review all of the information so you can feel confident about your plan. If taking this time before starting treatment concerns you, ask your doctor if there is any risk in waiting.

How to get a second opinion

Getting a second opinion involves finding a doctor who can provide the opinion and making arrangements to have your medical records sent to their office. But first, it’s important to let your current doctor know that you want a second opinion.

In this section, we’ll walk you through the steps of getting a second opinion.

How do I tell my doctor I want a second opinion?

Your doctor should not be offended if you seek a second opinion. Most doctors are comfortable with that choice and know that a second opinion can benefit your care.

You can ask your oncologist or another doctor to refer you for a second opinion. If you have a specific concern, such as wanting to find clinical trials for your type of breast cancer or protecting your ability to get pregnant in the future, mention that.

It may feel easier to ask for a referral if you say something like: “I appreciate your guidance and I want to be sure I explore all my choices before beginning treatment. Would you be willing to help me do that? Who can you recommend I see for a second opinion?”

Even if your doctor suggests someone, you do not have to consult that person. But it is important to let your doctor know if you are going to get a second opinion before treatment.

How to find a second opinion doctor

If you choose to look for a second opinion doctor on your own, here are some tips for finding one:

• In many cases, the cancer center or hospital where you are getting care can connect you to doctors who do second opinions.
• You may find a second opinion doctor at the same practice as your current doctor's or at another local practice.
• Breast cancer organizations and medical associations may also be able to help you identify a second opinion doctor.
• Family, friends, and other people who have had breast cancer might have suggestions. Just keep in mind that your treatment needs may be different than theirs.
• The American Society of Clinical Oncology and the American College of Surgeons offer help finding potential doctors.
• You can also look for a National Cancer Institute Designated Cancer Center to find a doctor for a second opinion.

A second opinion appointment doesn’t have to happen in person. If you’re not already being seen at a major cancer center or academic medical center, you may want to consider that option. At many major cancer centers, it’s possible to meet with a second opinion doctor online or by phone. This can open you up to more choices if you’re interested in getting a second opinion with a cancer center or institution at a location far away from you. Some centers offering remote second opinions include Harvard’s Partners in Healthcare, the Cleveland Clinic, and Johns Hopkins.

Check the background of all doctors suggested to you. You should easily be able to find information about reputable physicians on their hospitals' websites. You can also call the doctor’s office and ask the reception staff how long the doctor has treated your particular type of breast cancer.

Will my insurance cover a second opinion?

Most private and public insurance plans cover second opinions for treatment. Still, contact your insurance provider to find out if second opinions are covered under your plan, and confirm that any second opinion doctors you’re considering are in your insurance network. Insurers may require you to pay more to see doctors out of your network.

Some insurance companies require that you have a second opinion consultation before they will cover treatment expenses, so ask your insurance provider if this is required under your plan.

How to prepare for your second opinion appointment

Different hospital systems have different requirements for second opinion meetings. Once you’ve chosen a doctor and scheduled an appointment, ask the office staff what you’ll need to prepare for the appointment. You may be asked to gather some or all of these items:

• a copy of your pathology report
• your doctor’s treatment recommendations
• results from mammograms, ultrasounds, MRIs, and other tests
• biopsy slides
• a list of medicines you are currently taking

You can ask the office staff of your original doctor to help you gather all the necessary records and results. Sometimes, it’s possible to make these requests through your doctor’s online patient portal.

Your original doctor’s office will likely have you sign a release form that gives them permission to share your records.

Before the appointment, make a list of questions to bring with you. Here are some suggestions:

• How long have you been treating my type of breast cancer?
• Did your hospital’s pathologist agree with my pathology report?
• Do you agree with my doctor’s treatment recommendations? If not, why?
• What treatments do you recommend? What are the side effects of those treatments?
• Do I qualify for a clinical trial?

It’s not always easy to remember everything the doctor says, especially if you’re sorting out new information that’s coming at you quickly. Bringing a friend or family member along to take notes can help. You can also ask the doctor if it’s okay to record the conversation and if there are printed brochures or websites available with more information.

The second opinion doctor will review your medical records and may suggest additional testing. If you are meeting in person, the doctor will examine you. After that, you will discuss what the doctor recommends for treatment.

What are my next steps after a second opinion?

In many cases, the second opinion will match or closely match your original doctor’s recommendation. Having the second opinion gives you peace of mind that you did your research and made a good decision.

Sometimes, the opinions don’t match. In this case, you may need to decide whether to work with your original doctor or to go to the new doctor. In either case, with your permission, your second-opinion doctor may get in touch with your original doctor to share the opinion and to discuss your case.

It can be stressful when opinions differ, especially if you prefer your original doctor. Talk with your doctor about how you’re feeling. Consider asking for information about why the opinions may differ. Some questions to ask both doctors:

• Can you share the professional guidelines that support your opinion?
• What did clinical trials show about these treatment options in people with cancers like mine?
• Do outcomes vary based on these treatments, or do they work equally well?
• Are there differences in the side effects of these treatments?
• Would you feel comfortable giving me the other treatment? Why or why not?

If the second opinion is very different than the original recommendation, having the two doctors discuss your case together can be a good thing. It means that your situation is receiving more focused attention, and in some cases, doctors can come to an agreement on adjustments to your plan.

On the other hand, if your original doctor and the second opinion doctor continue to strongly disagree with each other, it may help to share the two opinions with a third breast cancer specialist. You can also request that your case be brought to your hospital’s tumor board, a group of doctors and other health professionals who meet regularly and share information and decision-making input on specific cases. A tumor board may include oncologists, surgeons, radiologists, pathologists, nurse navigators, and social workers.